Proliferative Diabetic Retinopathy in Type 2 Diabetes Is Related to Coronary Artery Calcium in the Veterans Affairs Diabetes Trial (VADT)

Abstract

OBJECTIVE -Increasing evidence suggests that macrovascular disease and retinopathy may be more closely linked than previously believed. We determined the relationship between retinopathy and coronary atherosclerosis as measured by computed tomography-detectable coronary artery calcium (CAC).RESEARCH DESIGN AND METHODS -The cross-sectional association between CAC and retinopathy was assessed on a Veteran Affairs Diabetes Trial subsample of 204 subjects with a mean duration of type 2 diabetes of 12.3 Ϯ 8.3 years.RESULTS -Retinopathy was correlated with CAC (r ϭ 0.19, P ϭ 0.006). Median CAC increased across retinopathy categories: 197 in those with no retinopathy, 229 in those with microaneurysms only, 364 in those with mild nonproliferative diabetic retinopathy (NPDR), 300 in those with moderate to severe NPDR, and 981 in those with proliferative diabetic retinopathy (PDR). Stepwise multivariable linear regression analysis was performed to find a parsimonious subset of relevant risk factors to include along with PDR in predicting CAC. After adjustment for either this subset of standard factors (P ϭ 0.047) or a more extensive panel of risk factors (P ϭ 0.035), PDR was significantly associated with CAC. Moreover, using logistic regression, individuals with PDR were approximately sixfold more likely to have CAC Ͼ400 than those with no PDR, even after adjustment for other CVD risk factors.CONCLUSIONS -These data indicate an important relationship between retinopathy and extent of CAC and suggest the potential to identify and treat shared risk factors for these common micro-and macrovascular complications. Diabetes Care 31:952-957, 2008

Megatrials in type 2 diabetes. From excitement to frustration?

“…Literature is now available to show that retinopathy predicts CV mortality in type 2 diabetes [33]. A cross-sectional association between coronary artery calcium (CAC) and proliferative diabetic retinopathy has been reported in a VADT subsample of diabetic patients [34]. Of note, the association remained statistically significant even after adjustment for multiple CV risk factors.…”

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

“…The early application of digital retinal photographs or fluorescein angiography can help physicians and ophthalmologists to screen for DR and determine its severity in patients with DM. Plenty of studies have reported that DR has a close relationship with CVD [15][16][17][18][19], and PAD, a subclinical CVD, is significantly associated with DR [20].…”

Paradox of using intensive lowering of blood glucose in diabetics and strategies to overcome it and decrease cardiovascular risks

“…(22) Results from the VADT and ACCORD suggested that intensive glucose control therapy in diabetic patients with a long duration of diabetes and preexisting CVDs had either no effect or was even detrimental in terms of cardiovascular and cerebrovascular outcomes. (23,24) Intensive glucose control therapy has inherent defects. (26,27) In fact, the targeted rates of blood glucose is very low all over the world in patients with diabetes melitus and most patients are actually in a constant state of hyperglycemia.…”